BMJ Open Respiratory Research (Jan 2021)
Improved COVID-19 outcomes in a large non-invasive respiratory support cohort despite emergence of the alpha variant
- Najib M Rahman,
- Robert Wilson,
- John M Wrightson,
- Nayia Petousi,
- Ian Pavord,
- Mona Bafadhel,
- Stephen Chapman,
- Rachel Hoyles,
- William Flight,
- Emily Fraser,
- Annabel Nickol,
- Dinesh Addala,
- Radhika Banka,
- Robert Hallifax,
- Anny Sykes,
- John Park,
- Patrick Elder,
- Anand Sundaralingam,
- Maxine Hardinge,
- Chris D Turnbull,
- Sarah B Evans,
- Rachel Lardner,
- Henry V Bettinson,
- Peter Saunders,
- Alastair Moore,
- Nicholas P Talbot,
- Maria Tsakok,
- Anastasia Fries,
- Simon Couillard,
- James Melhorn,
- Timothy Hinks,
- Andrew Achaiah,
- Benedict M L Porter,
- Oliver Smith,
- Eihab Bedawi,
- Hannah Danbury,
- Eric Douglas,
- Ling Pei Ho,
- Vishal Nathwani,
- Shefaly Patel,
- Hannah Laurenson-Schafer,
- Francesca Roxburgh,
- Evie Rothwell
Affiliations
- Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
- Robert Wilson
- Midlands, NHS England, Nottingham, UK
- John M Wrightson
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nayia Petousi
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Ian Pavord
- Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mona Bafadhel
- 2 Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Stephen Chapman
- professor of prescribing and head of medicines optimisation
- Rachel Hoyles
- William Flight
- Emily Fraser
- Oxford Interstitial Lung Disease Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Annabel Nickol
- 1 Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Dinesh Addala
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
- Radhika Banka
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
- Robert Hallifax
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Anny Sykes
- 3 Department of Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
- John Park
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Patrick Elder
- Anand Sundaralingam
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Maxine Hardinge
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Chris D Turnbull
- 1 Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Sarah B Evans
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Rachel Lardner
- respiratory physiotherapist
- Henry V Bettinson
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Peter Saunders
- Oxford Interstitial Lung Disease Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Alastair Moore
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nicholas P Talbot
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Maria Tsakok
- Anastasia Fries
- 2 Respiratory Medicine Unit and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Simon Couillard
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- James Melhorn
- 1 Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Timothy Hinks
- 1 Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Andrew Achaiah
- Translational Immunology Discovery Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
- Benedict M L Porter
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oliver Smith
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Eihab Bedawi
- Hannah Danbury
- Eric Douglas
- Ling Pei Ho
- Vishal Nathwani
- Shefaly Patel
- Hannah Laurenson-Schafer
- Francesca Roxburgh
- Evie Rothwell
- co-director of the Greener Healthcare & Sustainability Project
- DOI
- https://doi.org/10.1136/bmjresp-2021-001044
- Journal volume & issue
-
Vol. 8,
no. 1
Abstract
Introduction Respiratory high-dependency units (rHDUs) are used to manage respiratory failure in COVID-19 outside of the intensive care unit (ICU). The alpha variant of COVID-19 has been linked to increased rates of mortality and admission to ICU; however, its impact on a rHDU population is not known. We aimed to compare rHDU outcomes between the two main UK waves of COVID-19 infection and evaluate the impact of the alpha variant on second wave outcomes.Methods We conducted a single-centre, retrospective analysis of all patients with a diagnosis of COVID-19 admitted to the rHDU of our teaching hospital for respiratory support during the first and second main UK waves.Results In total, 348 patients were admitted to rHDU. In the second wave, mortality (26.7% s vs 50.7% first wave, χ2=14.7, df=1, p=0.0001) and intubation rates in those eligible (24.3% s vs 58.8% first wave, χ2=17.3, df=2, p=0.0002) were improved compared with the first wave. In the second wave, the alpha variant had no effect on mortality (OR 1.18, 95% CI 0.60 to 2.32, p=0.64). Continuous positive airway pressure (CPAP) (89.5%) and awake proning (85.6%) were used in most patients in the second wave.Discussion Our single-centre experience shows that rHDU mortality and intubation rates have improved over time in spite of the emergence of the alpha variant. Our data support the use of CPAP and awake proning, although improvements in outcome are likely to be multifactorial.
